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Home > Alcohol treatment matrix cell D3: Organisational functioning - medical treatment.

Drug and Alcohol Findings. (2020) Alcohol treatment matrix cell D3: Organisational functioning - medical treatment. Drug and Alcohol Findings Alcohol Treatment Matrix, .

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External website: https://findings.org.uk/PHP/dl.php?file=Matrix/Alc...


The Alcohol Treatment Matrix is concerned with the treatment of alcohol-related problems among adults (another deals with drug-related problems). It maps the treatment universe and for each sub-territory (a cell) lists the most important UK-relevant research and guidance. Across the top, columns move from specific interventions through how their impacts are affected by the widening contexts of practitioners, management, the organisation, and whole local area treatment systems. Down the rows are the major intervention types implemented at these levels. Inside each cell is our pick of the most important documents relevant to the impact of that intervention type at that contextual level.   

What is this cell about? About the treatment of alcohol dependence in a medical context and/or involving medical care, typically by GPs or at alcohol treatment or psychiatric units in hospitals. Clinical staff are responsible for medications, so the centrality of these to an intervention distinguishes it most clearly as medical. However, medications are never all there is to medical care, and in England most treatments do not feature them. Guidelines typically see psychosocial support as an essential component of treatment, and ‘medical’ treatment may consist entirely of advice and psychosocial support from clinicians. Apparent also in the studies listed in cell B2, how clinicians relate to patients affects whether they enter and engage in treatment. The clinician-patient relationship may also be a therapeutic influence in its own right. 

In turn, clinicians work in a physical and social context which more or less legitimises and supports their work, generally taking the form of a service run by a distinct organisation. As well as concrete things like staff, management committees, resources, and an institutional structure, organisations have links with other organisations, histories, values, priorities, and an ethos. These factors cumulate into an ‘organisational culture’: “workers’ understanding of ‘the way we do things around here’ ”. “Often overlooked … organizational culture communicates to workers the extent to which this type of work is appropriate, valued and worthwhile”, affecting whether the organisation offers an environment in which staff and patients/clients can maximise their potential. Among the activities affected by workplace culture is likely to be how keenly and effectively management and staff seek, identify and incorporate evidence-based practices. 

However, it is not easy for researchers to manipulate organisational culture and its constituents in order to test their roles in the implementation of evidence-based practices or their effects on outcomes for patients. Instead, observations of real-world practice look for links between organisational qualities and practice and outcomes which may derive from a causal effect of one on the other, but may be due to something else. Rigorous research is scarce, and studies not specific to substance use (incorporated in some of the documents listed above) become more important. 

This cell is about medical treatment. If research on an issue which interests you does not specifically relate to medical treatment, you may be able fall back cell D2, which deals with similar issues across treatment.

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